氯吡格雷在冠状动脉内支架置入术后临床应用效果观察

CLINICAL EFFICACY OF CLOPIDOGREL AFTER INTRACOROARY STENTING IN PATIENT WITH CORONARY ARTERY DISEASE

目的 评价氯吡格雷在冠状动脉内支架置入术后短期临床应用效果。方法 选择2002年3月—2003年7月因不稳定型心绞痛及急性心肌梗死行冠状动脉内支架置入术的患者,共103例。所有患者术前及术后服用氯吡格雷75mg/d,共4～6周,观察患者服药期间急性或亚急性血栓形成、心绞痛、再发心肌梗死和死亡等心血管事件及药物的不良反应。结果 103例患者中有1例患者术后1周死于心源性休克;1例急性前壁心肌梗死单纯行经皮冠状动脉腔内成形术患者,术后3h发生冠状动脉急性闭塞,再次介入治疗并置入支架后症状消失;其余101患者在服药期间无心血管事件发生。4例患者服药期间出现皮疹,停用氯吡格雷后皮疹消失,2例患者继续服用;服药期间未见粒细胞减少、出血、腹泻等副作用。对存活的102例患者术后随访1～12个月,1例患者术后3个月再发心肌梗死;1例患者术后6个月再发心绞痛;其余患者在随访期间无心血管事件发生。结论 氯吡格雷在冠状动脉内支架置入术后短期应用可预防支架术后急性或亚急性血栓形成,并且其副作用少。

Objective To evaluate clinical efficacy of Clopidogrel following intracoronary stenting in patients with coronary artery disease. Methods 103 patients with unstable angina or acute myocardial irfarction were treated with clopidogrel(75mg/day, lasting for 4～6 weeks)after intracoronary stenting from March 2002 to July 2003. The cardiac events(acute or subacute thrombosis, angina pectoris, acute myocardial infarction and death) and side effects of clopidogrel were recorded. Results 1 patient with acute anterior myocardial infarction died of cardiogenic shock after 5 days emerogent coronary stenting. 1 patient with acute anterior myocardial infarction receiving only percutaneous transluminal coronary angioplasty (PTCA) occurred acute closure after 3 hours procedure, and received repeat PTCA and coronary stenting. The other 101 patients didn't occur cardiac events in the period of using clopidogrel. There were 4 patients occurred rash during clopidogrel, 2 patients stopped clopidogrel because of severe rash, and 2 patients continued to take it after rash disappearence. The other side effects including granulocytic decreased, hemorrhage and diarrhea were not found. 102 patients were followed up during 1～12 months, 1 patient occurred acute myocardial infarction after 3 months procedure, 1 patient with recurrent anginapectoris after 6 months following-up were confirmed restenosis by repeat angiography, and the other 100 patients had not any cardiac events during following-up. Conclusion Short term usage of Clopidogrel can prevent acute or subacute thrombosis after intracoronary stenting, and there are little side effects.